Dr. Richard Ferber, a renowned pediatric sleep specialist proposed a sleep routine for infants through his book, "Solve Your Child’s Sleep Problems", published in 1985. Let’s drill down the famous Ferber’s method of sleep training or as is commonly called, the "cry-it-out" method, and explore what it is all about.
The Ferber method of sleep training might seem like it signals the end of baby talk, cuddling and lullabies as the universal bedtime routine of many parents trying to slip their precious little ones into “sleep mode”. But there’s more to it than just ignoring a baby and being callous towards its needs, in fact, that’s hardly the intention. But here’s a thought that’s funny but universally true.
“Insomnia: A contagious disease often transmitted from babies to parents.” ~ Shannon Fife
Newborns are characterized by their extremely erratic sleep schedule and constant need for attention, cuddling, rocking and feeding. Many infants are able to sleep somewhat regularly for a longer span of time when they’re about 3 – 6 months or older. But for several new parents, a good night’s rest is a foregone luxury even with a growing baby. This is where Dr. Ferber’s self-soothing technique can prove useful. The Ferber method suggests that parents need to train their child to sleep without depending on constant reassurance, cajoling and rocking from the parents. The child must “realize” that it’s time to sleep and that you’re not going to provide constant supervision or “handling”.
The trouble usually starts when the baby is being separated from its mother at bedtime. The transition from being so close to the mother at all times to being on its own in a crib with no one to cuddle up to is a major adjustment for a baby, albeit a necessary one. Please ensure that you’re not going to try this technique on a baby who’s physically ill or frightened due to some event. You can postpone Ferberizing your baby until it is hale and hearty and back to normal. Here are the steps that help your baby sleep on his/her own with the Ferber method.
- A warm and loving bedtime routine is the precursor to self-soothing. You can include the hugging, rocking and cuddling, even the lullaby need not be left out, in this phase.
- The first night will most likely be a long one, so prepare to lose some more sleep. Put the child to bed when tired and on the brink of sleep, but mostly awake.
- Now leave the room or the crib area such that you’re not really “around the child”. The baby will usually start crying at this stage. Do not rush back to the crying child.
- If you’re one of those new parents who feels extremely guilty at leaving your child alone and crying away, make use of a baby alarm so that you’re assured there’s no real harm.
- After about 4-5 minutes of crying, you can re-enter the room but only to show your presence. The idea is to let the baby know that you’re still looking out for him/her but you’re not going to give in and start picking up and rocking the child. You may assure the child verbally and through patting. Even if he/she is still crying, extending his/her arms out, resist the urge to respond.
- Now leave the room again and return after about 8-10 minutes. Yes, this is going to take some time and effort initially, so don’t pick a week that’s particularly hectic and you’re in a hurry to retire to bed.
- After a couple of reappearances, increase your “away” time to 15 minutes and let it stay that way for the rest of the night.
- The first 2-3 nights may be extremely discouraging both for you and your child but remember that the agony will pass soon. Eventually your child will fall asleep and the time taken will reduce in subsequent attempts. Depending on how soon your child adapts to your “away” time, increase the interval from 15 to 20 minutes and then by 5 more minutes thereafter.
- Your child will eventually learn that excessive crying is only going to get you to come and check regularly, nothing more. It is also important for you to know that the crying is due to your absence and not due to any physical discomfort or hunger and thirst. Ensure that you are feeding the child enough during the daytime. Transitioning from night feeds should be done prior to Ferberizing or you may have to interrupt the bedtime routine to feed the child, thus defeating the purpose of the program. The Ferber technique is known to be generally effective within the first couple of weeks and will be a more long-term solution to your child’s sleep problems.
Ferberization is “Not” for All Kids
Just as all medicines do not suit all children, similarly even with non-invasive therapy or techniques there are some cautionary aspects. Do not use the Ferber method on your child if any of the following conditions is true.
- If your child is less than 6-12 months old and is being administered night feeds
- If your child has a conditioned fear of being left alone or suffers from other sleep disorders such as bed-wetting, night terrors, etc., which require specific treatment
- If your child vomits violently and frequently as a usual response to the Ferber routine
- If there is any sudden change in the normal behavior of the child (daytime stress, headaches, etc.) as a consequence of the Ferber routine
In all the above cases, discontinue the method and seek medical advice.
Differences of Opinion Over Ferberization
Ferberization or graduated extinction has historically been criticized by numerous pediatricians, parents and sleep experts. The widespread allegation is that the Ferber approach is cruel and likely to create emotional scars that will last a lifetime for the child. Reportedly, misinterpreting and misunderstanding Dr. Ferber’s recommendations in his first book have also resulted in difference of opinions.
For example, a common myth is that the Ferber approach advocates ignoring your child even if he/she vomits during the routine and critics even imply that such vomiting is a goal of Ferberization. This is completely misconstrued and false. It is normal for infants to vomit or throw up the contents of the latest feed due to the effort involved in excessive crying. What Dr. Ferber suggests, is to continue the routine after cleaning up the mess or resume the next day without mistaking it for an emotional response of being left alone. He merely suggests that parents need to be consistent with the program to realize its benefits.
In the latest (2006) edition of the book, Dr. Ferber takes on his unreasonable critics and clarifies his approach stating categorically that “cry-it-out” is not the approach he approves of. In fact, progressive waiting cannot be taken as callousness or ignoring. He also agrees that sleep training is just one approach to prevent parents from frequently comforting their child who in turn constantly desires their proximity. He proposes a set of different approaches to deal with sleep problems of a child. He also goes on to agree that every child needs customized solutions for his/her sleep problems. One approach cannot work for all children.
However, some sleep experts still do not approve of the Ferber approach. Some believe that studies have proven that crying is physiologically stressful for a child, increasing its heartbeat and blood pressure and an approach like Ferber’s might put babies at an unnecessary risk. Others who disapprove of Ferber’s approach express the fear that separation anxiety in children might develop negative feelings about parents in them. They could also develop a reduced sense of security and could grow up to become constantly edgy. However, there’s no conclusive research evidence to prove these adverse effects. Then there’s the cultural aspect where parents feel extremely guilty and even feel they’re being abusive by not tending to the child while he/she is crying.
Is Ferber’s Method Inappropriate?
For all the critics of the method you will undoubtedly find several others who have indeed benefited from the program. While we are not authorized to provide medical suggestions, it is important to know that a customized program that employs Ferber’s method in addition to other alternative techniques for sleep training could work for your child. One such technique is positive routines with faded bedtime.
This approach entails associating bedtime with relaxation activities like dimming the lights, preparing for bed, avoiding stimulating activities (such as playing with a ball, etc.) and generally creating a “sleepy atmosphere”. This way the baby learns to gradually time his/her sleep around these events. Other techniques, some of which seem to derive from Ferber’s approach are letting the parent be next to the child until he/she falls asleep, progressively paying less attention each night and letting the parent sleep in the same room but in a different bed.
You know your child best in terms of his/her personality as well as physical responses. You can judge whether the child needs a feed or simply, attention and affection. It is up to you to design a sleep routine most suitable to your child that could use some of the techniques mentioned above. Age-appropriate techniques can work wonders as opposed to subjecting infants to strict routines.
However, consistency is vital for the success of any technique. If you give up on the routine by responding to crying, tantrums and protests, you will not only fail in establishing the routine, but the child will also gradually learn to manipulate your responses by frequently resorting to disruptive behavior. It is important to find a balance between debated techniques like the Ferber’s method and your own judgment of your child’s behavior. Remember that it is important for your child’s well-being as well as yours that both of you should get adequate sleep and rest.
Disclaimer: Please be aware that this article is for informative purposes only. It is neither intended nor implied to be a substitute for professional medical advice. The article neither recommends nor discredits Ferber’s technique.